FORM D
ENFIELD PUBLIC SCHOOLS Report of Bullying / Consent to Release Student Information
Date : Name of Student :
________________________________ ________________________________
School :
________________________________
To Parent / Guardian :
A report of bullying has been made on behalf of your child alleging that he / she has been the victim of bullying . In order to facilitate a prompt and thorough investigation of the report , the Enfield Public Schools may wish to disclose the fact that this complaint has been filed in connection with investigation .
( Please check one ):
_______ I hereby give permission for the Enfield Public Schools to disclose the fact that a complaint concerning my child has been filed as part of its investigation of that complaint .
______ I do NOT give permission for the Enfield Public Schools to disclose the fact that a complaint concerning my child has been filed as part of its investigation of that complaint .
_________________________________________ Signature of Parent / Guardian
Date
_________________________________________ Name ( Please print )
Adopted : January 24 , 2012 Revised : March 27 , 2012 Revised : May 12 , 2015
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